Several types of midwives and several types of physicians provide
prenatal care, attend births, and care for women after birth in the
United States. This page provides information about these options.

The
great majority of childbearing women in the U.S. are well and healthy,
and can consider choosing from among the full range of maternity
caregivers. If you have a serious medical condition or are at high-risk
for developing such a condition, you will probably want to (1) be in
the care of a doctor who has completed a residency and is
board-certified in obstetrics (see below), and (2) plan to give birth
in a hospital. Maternity caregivers understand and can advise you about
situations that may call for more specialized care.

Views
of the childbearing process and of appropriate care for childbearing
women vary. Two contrasting perspectives are often called the
"midwifery Model of Care" and the "Medical Model of Care." There are
striking differences in the two models. These differences can have a
great impact on your experience and outcomes.

Focus on managing problems and complications Labor/birth as dependent on technology Higher rates of using interventions Doctor delivers baby Care is routinized

Naturally,
the midwifery model describes the practice of many midwives, and the
medical model describes the practice of many doctors. But many
caregivers combine elements of both. It is possible, but less common,
to find doctors whose practice most closely resembles the midwifery
model of care and midwives whose practice most closely resembles the
medical model.

Thinking about these different views can help
you to understand your own values and ideas about pregnancy and birth,
and can help you select a caregiver who is compatible with your needs
and values. Many women have a clear preference for one or the other of
these models.

Midwives are well-suited to care for healthy
women who expect to have a normal birth. They provide prenatal care,
care during labor and birth, and care after the birth. Many give
priority to providing good information to women, involving women in
decision-making, and providing flexible and responsive care. Many work
to avoid unnecessary tests and treatments; and women under the care of
midwives typically are less likely to have a cesarean, an episiotomy,
and other interventions than women receiving care from doctors. Some
midwives provide continuous support throughout labor and birth, which
has many benefits for women, infants, and families and no known risks.
midwives often encourage, are well-informed about, and provide much
support for breastfeeding.

Some midwives also have additional
training and credentials for childbirth education, breastfeeding
consultation, and/or doula care.

Midwives
attend births in many hospitals throughout the United States, and they
attend most of the births that take place in out-of-hospital birth
centers and homes. They provide prenatal care and care after birth in
many settings.

At this time, midwives attend about eight
percent of births in the U.S. — over 300,000 every year. The trend
shows a steady increase in use of midwifery services over time. (In
1975, midwives attended about one percent of U.S. births.) In contrast
to the U.S., midwives are the most common maternity caregiver in many
countries in Europe and elsewhere.

Certified nurse-midwives (CNMs)
are educated in the two disciplines of nursing and midwifery. They are
registered nurses who have graduated from a nurse-midwifery education
program accredited by the American College of Nurse-Midwives (ACNM).
They are "certified" when they pass an exam of the ACNM Certification
Council, and are licensed by their state to practice nurse-midwifery.
All 50 states license CNMs, and most midwives who practice in the U.S.
are CNMs.

CNMs are trained to provide prenatal care, care
during labor and birth, and follow-up care to the mother and newborn
after the birth. Most CNMs attend births in hospitals, but they also
attend births in out-of-hospital birth centers and in women's homes.
CNMs may also provide "well-woman" care, such as gynecological
checkups, pelvic and breast exams, and pap smears, as well as family
planning care.

CNMs may work within a midwifery-owned and led
practice, in a practice with physicians, or as employees of hospitals,
health plans, or public agencies. In all cases, they are required to
have established relationships with physicians for consultation,
collaboration, and referral, as needed.

Certified professional midwives (CPMs)
have passed the certification examination of the North American
Registry of midwives (NARM). Candidates for this exam are educated in
core content areas, complete a core set of clinical experiences,
demonstrate core skills, and present practice plans (including care
guidelines and an emergency care plan). The NARM certification process
recognizes multiple routes of entry into midwifery, and most CPMs
become midwives without first becoming a nurse. Many states in the U.S.
license CPMs or legally recognize them in other ways.

The CPM
credential requires knowledge of and experience in out-of-hospital
settings, and most CPMs attend births in women's homes or in
out-of-hospital birth centers. They usually do not practice in
hospitals. CPMs provide prenatal care, care during labor and birth, and
care of the new mother and her baby in the early weeks after birth.

Certified Midwives (CMs)
are new professionals in the health care field. The American College of
Nurse-Midwives (ACNM) has recently begun to certify midwives who do not
also have training in nursing. Although not registered nurses, CMs may
have backgrounds as physician assistants, physical therapists, or other
health practitioners. CM education closely mirrors the education of
certified nurse-midwives, and CMs graduate from an education program
accredited by the ACNM. CMs are "certified" when they pass the same
exam that the ACNM Certification Council gives to certified
nurse-midwives. The settings in which they practice and the care they
provide are comparable to CNMs. New York is the only state with CM
licensure at this time.

Other midwives offering home
birth services do not have any of the above credentials. State
regulatory mechanisms for such midwives vary widely, from recognition
to prohibition of their practice. Although they may have considerable
education and experience, established arrangements for consulting with
and referring to physicians, and other important qualifications for
midwifery practice, women who are considering using their services must
carefully explore these questions with the midwife.

Founded in 1918, Childbirth Connection has joined forces with and become a core program of the National Partnership for Women & Families. Together, these two women's health powerhouses are transforming maternity care in the United States.

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